"The difference between fiction and reality?
Fiction has to make sense."
-- Tom Clancy

Friday, July 8, 2011

A Tale of Two Patients

Two different patients & two different doctors' offices.

Two patients limp into two different medical clinics with the same complaint. Both have trouble walking and appear to require a hip replacement.

The FIRST patient is examined within the hour, is x-rayed the same day and has a time booked for surgery the following week.

The SECOND sees his family doctor after waiting 3 weeks for an appointment, then waits 8 weeks to see a specialist, then gets an x-ray, which isn't reviewed for another week, and finally has his surgery scheduled for 6 months from then.

Why the different treatment for the two patients?

The FIRST is a Golden Retriever.The SECOND is a Senior Citizen.

Next time take me to a vet!

This would be a funny joke if it weren't so true.

Back when President Barack Obama was trying to justify his massive takeover of the American health care system, through his Obamacare bill (a.k.a. the horribly misnamed "Patient Protection and Affordable Care Act", or PPACA), one of his justifications was that private insurers were denying so many claims. Of course, he failed to mention that Medicare  our national health care program for senior citizens  denied medical claims at more than twice the rate of the private insurers. More examples, more coverage horror stories, have been coming out since then. Here is one more to add to that list.

Let me introduce Mrs Erlinda Moya. She has lived more than 99 years; she will soon have her 100th birthday. She is loved by the members of her parish, and cared for by her daughter and family. Her health has been good but, just in case of a medical need, she is covered by both Medicare and Medicaid (under the disabled and elderly waiver), as well as by Blue Cross Blue Shield.

Not long ago, Mrs Moya got an infection in a toe. It was a stubborn one, and she was hospitalized. It took a while to find an antibiotic that was effective against her infection, and the toe had to be amputated. Medicare paid for all of the medical care, and all the supplies and facilities that were needed.

The doctors said Mrs Moya would need IV antibiotics for another five weeks to completely get rid of the infection. Medicare wanted to put her in a nursing home for that five weeks to handle the IV infusions. That would keep her instutitionalized, and away from her family. The family, naturally, wanted to bring her back home instead. And they were told that, while Medicare would cover the full nursing home cost (more than $7000), Mrs Moya would have to pay $60 a day for the five weeks (a total of $2100) if the family took her home. There's no way her limited income could cover that kind of cost!

Medicare didn't want to budge. They weren't interested in saving $5000 and getting a better medical outcome by letting Mrs Moya go home to her family. (And that's assuming the $2100 is a government rate as well as a private-pay rate.) Medicare was only interested in pressuring the family into putting her in an institution. They wanted to pay $7000 unnecessarily for institutional care, or make Mrs Moya pay $2100 to be with her family. Those were their only choices.

That is bureaucratic stupidity, at best.

Fortunately for Mrs Moya, another solution was found  a solution outside the Medicare system. A caring case worker put the family in touch with Walgreen's, from which they obtained the antibiotics at a nominal cost for infusion by Mrs Moya's son. As a result, Mrs Moya is with her family, is improving, and is looking forward to her 100th birthday.

There is a lesson to be had here. Programs don't care about people. Bureaucracies don't care. Rules and regulations don't care. But  sometimes  individual people do care. The system makes it hard for them to do so, but sometimes they do anyway. And when they do, they can sometimes find a way to force an unwilling bureaucracy to use at least a little common sense.

There is also an epilogue. Mrs Moya's tale touched Mrs Critter. As is frequently the case, she took action in response. She wrote to Senator Jeff Bingaman about it. She noted that Mrs Moya has voted for Senator Bingaman many times, and now she needs some protection from a system too big to care. What she got in return was a form letter that stated "I understand your concerns regarding the new health care reform law." and claimed major benefits for "the new health care reform law" (Obamacare) including the claim that "it significantly reduces the federal deficit by $1 trillion dollars." (At least he got the amount right - he just got the sign wrong.) Interestingly, the Senator's letter never names "the new health care reform law", either as Obamacare or as the Patient Protection and Affordable Care Act - Obamacare's formal name.

This response angered Mrs Critter, and she replied to Senator Bingaman saying

Senator and staff,

I am so frustrated at the way you waste my money!!! I wrote to you about a specific case of Mrs. Moya, a 99-year old woman who has Medicare, Medicaid, and Blue Cross Blue Shield and her family's frustrations securing the care she needs and you respond with a FORM LETTER. She is a real live person whom YOU have failed. If you have failed her and simply fold your hands, THAT is the real answer to my concerns about how OBAMACARE will fail the nation. The health care you have imposed on us now has failed Mrs. Moya -- what a waste of taxpayer dollars!!! Obamacare will be bigger and much more expensive and will fail all but the politicians. Yes, I am angry that you respond to a real life situation with a form letter and sit on your hunches while Mrs. Moya and her family struggles with her health care situation. You are useless!!!! We should start by cutting your staff and your retirement benefits should be need-based.

GRRRRRRRRRRRR.

So there is no good news on the bureaucratic front. The only good news is still that Mrs Moya is with her family, is improving, and is looking forward to her 100th birthday.